Is this business US Small Business Association Certified?requiredYesNo

Check all that apply to this business (Defined as 51% or more)

Women Owned

Minority Owned

Veteran Owned

Disabled

Disadvantaged

Businesses that meet these qualifications are required to upload supporting documentation

Payment TermsEFT is Net 5: Electronic Funds Transfer direct to your bank account (Payment within 5 business days of receipt of invoice in Brown Accounts Payable)Net 30: Paper Check (paid within 30 business days of receipt of invoice in Brown Accounts Payable)2% is Net 15: Paper Check (2% discount to Brown, paid within 15 business days)

requiredCertification - select one:
W9 Certification: Under penalties of perjury, I certify that: (1) The number shown above is my correct taxpayer identification number; (2) I am not subject to backup withholding due to a failure to report interest and dividend income, (3) I am a U.S. person (including a U.S. resident alien), (4) I am exempt from FATCA (Foreign Account Tax Compliance Act) reporting.
I am a foreign national and not required to complete form W-9.

Bank Account Information (optional)

EFT (Direct Deposit) payments are available for U.S. Banks Only.

This form authorizes Brown University to make payments to a business or individual electronically. deposits funds into the account, the University and the bank are authorized to initiate the transaction(s) necessary to correct the error. This electronic payment authorization will remain in effect until the University has received written notification from the payee to terminate and the University has had reasonable opportunity to act upon it.

Notification of payments will be sent by email, with the payment settling into your bank account within two days. It is the responsibility of the business or individual to notify Brown of any changes pertinent to electronic payments, such as changes in banking information or email address.

Select account type:
Checking
SavingsName of Bank

Name on Bank Account

Bank Routing Number (9 digits)

Account Number

How to Find the Routing Number on Your Check

Funds Transfer: To comply with the requirements of the U.S. Department of Treasury and Office of Foreign Assets Control (OFAC), Brown is obligated to ask the question shown below regarding the transferring funds. If your answer is “Yes”, Brown will issue a paper check in lieu of processing a direct deposit.

Are funds transferred to the designated direct deposit account and then transferred to a bank
in a foreign country? YesNo